Integration of all support systems in the clinical environment.

Evidence based medicine (EBM) is an approach to patient care which ensures that potential advances in health care must be tested and proven to do more good than harm before they are incorporated into medical practice. It promotes the collection, interpretation and integration of patient reported, clinician observed and research-derived evidence. For this information to be used as an integral part of medical practice, regularly updated systematic reviews such as those organised through the Cochrane Collaboration are essential. It has been argued that electronic access to information sources from the health care professional's normal work place is the only feasible way to bring EBM into routine clinical practice where it is used as a framework for determining the care of individual patients.Within the context of clinical decision-making using EBM, two sources of information are necessary. Firstly patient information, which includes treatment regimes, clinical assessments and the results of laboratory tests on a particular patient. Secondly reference information, which is the evidence base on which to justify the care delivered to that patient. It is believed that bringing patient and reference data together so that they can be accessed through a single workstation within the hospital workplace could provide an effective tool to support healthcare delivery using EBM. The concept of the clinical workstation is one that has been used to describe a single workstation which gives access to all clinical information. If this concept is applied to a workstation to support EBM, then both patient specific and reference information must be available through the workstation. This study describes work at the Royal Hallamshire Hospital (RHH) in Sheffield, an acute 850-bedded teaching hospital located in an industrial city. The work aims at integrating access to reference and patient data through a single user interface - a Web browser - as a method of providing direct support for the delivery of EBM. A user-centred iterative approach to the research has been employed and in this study the user requirements and a prototype workstation to support evidence based medicine are described and evaluated.